I had a great chat with Dr. Adrian Huang, an upper extremity surgeon at UBC (@scrubbedout) about distal radius fractures. We talked about the optimal closed reduction and casting maneuvers, common fracture patterns based on the anatomy, and a neat intra operative technique to maximize exposure without injuring the median nerve. Find some awesome content on his website and social media:
IG: instagram.com/scrubbedout/
Website: scrubbedout.com
1:15-3:45 - Definition of “distal radius fracture”, epidemiology, identification in polytrauma/comatose pt
3:45-6:00 - Anatomy of DR, osteology, joints, patterns; that unstable lunate facet - https://doi.org/10.2214/ajr.13.12140
6:15-8:35 - Extra-articular DR fracture management, 5 criteria for ORIF, post-reduction films, critical volar cortex component; https://www.orthobullets.com/trauma/1027/distal-radius-fractures “ORIF Indications”
8:35-16:00 - Closed reduction maneuvers; hematoma block, finger traps, casting technique, common complaints, 1st web space, out to MCPs, distal to elbow crease, hinge at fracture (not wrist)
16:00-16:45 - Smith fractures, reverse molds, median n, close followup
18:00-19:00 - Indications for ORIF are multifactorial; https://www.scrubbedout.com/distalradiuscheatsheet
19:00-23:00 - Modified approach per @scrubbedout; https://www.instagram.com/p/CIZgdXyB35h/ has less median n stretch, Orbay approach; https://doi.org/10.1097/00130911-200112000-00004 . Cover hardware with PQ/BR to reduce need for removal
23:00-26:15 - Avoid damaging NV by not using sharp/self retainers, always fix what you remove (eg: RC ligaments), don’t miss associated injuries (eg: scaphoid/lunate)
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